Swasthya Sathi : Complete Scheme Details & Coverage

Swasthya Sathi Scheme in a Brief

Mamta Banerjee, the Chief Minister of West Bengal State, launched a new Swasthya Sathi Health Scheme 2021 that would cover the whole population of West Bengal State. The Chief Minister of West Bengal State has introduced a slew of new initiatives to assist citizens in improving their livelihoods and avoiding the disastrous consequences of the coronavirus. New plan was implemented on December 1, 2020, according to the Chief Minister’s statement. She further stated that the whole Cashless Health Scheme was sponsored by the West Bengal State Government.

Swasthya Sathi Official Announcement

Swasthya Sathi was declared in Cabinet No. 2625 on February 17, 2016, and in Finance Department notice No. 1104-F (P) on February 25, 2016. On December 30, 2016, the Hon’ble Chief Minister of West Bengal formally launched the initiative.

The Swasthya Sathi Key Highlights:

  • Basic health coverage for secondary and tertiary treatment up to Rs. 5 lakh per year per household.
  • Paperless, cashless, and smart card-based.
  • All pre-existing conditions are covered.
  • There is no family size limit, and parents from both spouses are included.
  • All physically handicapped dependents in the household are likewise insured.
  • State government pays the whole premium, with no contribution from the insured.
  • Swathya Sathi Smart Card is given to all families on the day of enrollment.
  • The family members’ information, photographs, biometrics, address, mobile number, and SECC ID are all stored on the smart card.
  • A paperless IT platform has been used since day one to manage the project.
  • Hospitals are rated and enlisted on the online platform depending on their services and infrastructure. Pre-authorizations are processed 100% online and take 24 hours.
  • SMS triggers and rapid warnings to beneficiaries on card blockage
  • Real-time uploading of beneficiaries’ E-health records on discharge
  • Claim reimbursement to the hospital with a TAT of 30 days or interest is levied for late payment
  • 24X7 toll-free Call Center (18003455384) with feedback option
  • Online grievance monitoring Mechanism
  • Online triggers and warnings to identify potential fraud with escalation matrix.
  • Android-based Swasthya Sathi Mobile app for beneficiary help
  • The Swasthya Sathi Form can be downloaded directly form the Official Website

Smart Card) Swasthya Sathi Scheme 2021

Apply Online, Beneficiary List WB Swasthya Sathi Scheme | West Bengal Swasthya Sathi Smart Card Apply Online | West New Cashless Health Scheme Online Registration & Eligibility

Today, we shall share and take you through the details of the new 2021 Swasthya Sathi program so that you may apply for it and get the benefits of excellent healthcare affordably or absolutely free.

We will also discuss the eligibility and age criteria for applying for the Swasthya Sathi Smart Card project, which was announced by the Chief Minister of West Bengal State for the fiscal year 2021.

We’ll also guide you through the application procedure for the Swasthya Sathi for the year 2021, as well as how to obtain this smart card.

Advantages of Swasthya Sathi Cashless Health Scheme 2021

According to estimates, at least 7.5 crore people are expected to participate in West Bengal’s Cashless Health Scheme. The state’s Chief Minister stated that the Swasthya Sathi plan will cover every family in West Bengal. The Chief Minister further claimed that the Central Government only pays 60% to the Ayushman Bharat Yojana, but the State Government will finance 100% of the Swasthya Sathi Cashless Health Scheme.

The major benefit of this strategy will be provided by the smart card. Each family will be given a smart card that will be accepted at all government and private hospitals in West Bengal.

Name of the SchemeSwasthya Sathi Scheme
BenefitSmart Health Card
Initiated byChief Minister Mamata Banerjee
Launched by West Bengal State Government
ObjectiveProviding Affordable Health Services
BeneficiaryPeople of West Bengal State
Official sitehttps://swasthyasathi.gov.in/

Swasthya Sathi Form : Apply Card Online , Form Fill Up & Login

Swasthya Sathi  Hospital List : Services & Facilities

Letter of Appreciation for the Swasthya Sathi Scheme

As you are all aware, the West Bengal Duare campaign is being implemented throughout the state. As a result of this campaign, individuals are enrolling in different government programmes. According to West Bengal government plans, all Swasthya Sathi recipients who joined through the Duare Sarkar campaign would receive an official letter from West Bengal government on January 8, 2021. Chief Minister Mamata Banerjee will write this letter. This letter is to express thanks for a message sent to Swasthya Sathi plan beneficiaries. The Chief Minister addressed the recipients as “Dear Companions” in this letter. And she told us about the Duare campaign, which will begin at the beginning of next year, on December 1st.

She further mentioned in this letter that with the help of this campaign, the West Bengal government will provide the people of West Bengal with the benefits of 12 programmes. Up to January 7, 2021, about 1,88,99,552 individuals visited the 665 Duare Sarkar camps.

Statistics on the Swasthya Sathi Scheme

Families that are Covered under the Swasthya Sathi Scheme2 Crores plus
Hospital Enlisted under the Plan2260 plus
Hospitalization Done till date20 Lakhs plus

Rate Concerns Regarding West Bengal Swasthya Sathi Scheme

The West Bengal government gives Swasthya Sathi programme Health Insurance up to Rs 5 lakh to all recipients. Healthcare officials and private hospitals met on December 27, 2020. Representatives from private hospitals gathered to discuss treatment fees under the swasthya sathi scheme.

They think that the Swasthya Sathi programme has exceptionally low rates. According to Roopak Barua, president of the Association of Hospitals of Eastern India, the meeting was productive and useful. The importance of Health Insurance Coverage has been contested by both the government and private healthcare providers.

  • The private hospital expressed some reservations.
  • The first issue was the cost of treatment under the Swasthya Sathi programme.
  • Private hospitals have asked the government to adjust the tariffs under this programme since they are so cheap. The payment of treatment costs and the type of therapy were also reviewed during the conference.
  • Private hospitals have also asked the government that no payments be deferred for months.
  • A decision was made to improve infrastructure and equipment during this meeting.

SurgeryRate of Surgery
Common SurgeryRs 19,500
Replacement SurgeryRs 85,000
Open Heart SurgeryRs 80,000

You may Check the Rates here below

Swasthyasathi Package Lookup

Click here to view the updated Rates of Swasthya Sathi Card

Swasthya Sathi Smart Card

Swasthya Sathi Smart Card is a smart card that was developed by Swasthya Sathi

As part of this initiative, Swasthya Sathi Smart Cards would be offered to households with at least one elderly woman. People will be able to get health benefits at any of the commercial or public government hospitals that accept the Smart Card. Because the initiative has been extended to all families in West Bengal State, there are no precise eligibility requirements that must be met. The state government has spent around Rs. 2000 crore each year on this Health Scheme. Smart cards will allow individuals to receive various treatments without having to pay any money to the hospital administration.

Eligibility Criteria for the Swasthya Sathi Scheme

To qualify for the Cashless Health Scheme, the applicant must meet the eligibility requirements listed below.

• The candidate must be a permanent resident of West Bengal state.

•The smart card will be distributed to the family’s female prospects.

• An applicant must not be registered in any other government health-care programme.

The Importance of the Swasthya Sathi Scheme

  • The Swasthya Sathi Scheme 2021 will offer basic health coverage for secondary and tertiary care at a cost of Rs 5 lakh per family per year.
  • All treatments will be paperless, cashless, and based on smart cards.
  • All pre-existing illnesses are covered under the plan.
  • There are no restrictions on the size of the family.
  • The Swasthya Sathi Scheme insures both spouses’ parents, as well as all dependent physically challenged members of the family.
  • The West Bengal government will cover the whole premium cost under the Swasthya Sathi scheme.
  • There is no premium to be paid by the beneficiaries.
  • Each enrolled family will receive an online swasthya Sathi smart card including information about family members, a portrait, biometrics, an address, a cellphone number, and so on.
  • The swasthya Sathi programme provides 24-hour phone support.

Lakshmi Bhandar Scheme West Bengal 2021 | Apply Online @wb.gov.in

Swastha Sathi’s Major Purpose.

  • No exclusions: The scheme covers all pre-existing ailments and illnesses from day one.
  • No Family Size Cap, Parents of Both Spouses Included& Gender Empowerment: There is no family size cap, and parents of both spouses are covered. Cards are usually issued in the name of the eldest female family member as the Head of the family.
  • No Beneficiary Contribution:  Because West Bengal’s government pays the whole premium, including the cost of smart cards, the beneficiary is not required to pay any insurance premiums or card fees.
  • All Completed Transactions based on Smart Card Transactions: The beneficiary is provided with paperless, cashless services that are entirely based on the 64Kb Smart Card, which comprises electronically confidential message imprinted on the card and handed to just the beneficiary during the registration procedure.  Smart cards have a lifetime validity and are automatically renewed each year.
  • The scheme’s whole structure is paperless and developed on a hassle-free cloud-based IT platform. Apart from guaranteeing that services are supplied as soon as feasible, online monitoring of the programme saves valuable time and resources.
  • Treatment Pre-Authorization: All Swasthya Sathi beneficiaries’ medical procedures/treatments are 100% pre-authorized within 24 hours TAT (turnaround time).
  • Transparent Hospital Grading: Hospitals are graded on available facilities and services, which are physically verified by the IC/TPA (Insurance Company/Third Party Administrator). The Empanelment Committee confirms the grade and appoints the hospital to the Swasthya Sathi network.
  • Complete Cashless Hospitalization: Expenses for consultation, diagnostic tests, and medicines up to one day before the patient’s admission, as well as the cost of diagnostic tests apart from food during hospitalization and medicine up to five days after discharge from the hospital for the same ailment or surgery, are reimbursed to the beneficiary.
  • I Rational Package Rates: There are 2092 Swasthya Sathi packages in the scheme. Package pricing is variable, and the Package Selection Committee rationalizes package charges as appropriate.
  • Text Message Alerts: Beneficiaries receive text message alerts during their stay and after their release.
  • Swasthya Sathi Mobile App: Available from the Google Play Store, this app allows you to request information, file a complaint, and so on.
  • This also features a one-touch function that connects to the Help Line 24 hours a day, seven days a week.
  • In addition, the back of the Swasthya Sathi Smart Card has a 24-hour toll-free help call centre (Number-18003455384) that may be contacted.
  • Beneficiaries can also communicate with one another using social media platforms such as Facebook, Twitter, and WhatsApp.
  • Transport Allowance After Discharge: The package includes Rs 200 in transportation expenses payable to the patient at the time of discharge.
  • Additionally, patients admitted to state-run hospitals receive a travel stipend of Rs 200 in addition to the Rs 200 that they would have received otherwise.
  • Extensive network of Empanelled Hospitals: Under the Swasthya Sathi scheme, beneficiaries can seek treatment at around 1500 empanelled hospitals, the information of which are made public. A growing number of hospitals self-register for the plan on a daily basis.
  • Mandatory Claims Settlement through TAT of 30 Days: The claims of the Health care providers are monitored and resolved online within 30days, or else interest would have to be paid as per the Agreement.
  • Mandatory E-HR (E-Health Record) upload on portal: The patient’s e-Health records are kept on the server and may be viewed as and when necessary by physicians using their login credentials. As a result, all stakeholders, including the public, have access to the report.
  • Web Grievance Monitoring Mechanism: Stakeholders can file a complaint using the Swasthya Sathi online site.
  • There are System Based Triggers Against Hospital/TPA/Insurance, such as hospitals with excessive admissions, a high number of high value packages blocked, a higher package banned and claimed but not really done, needless surgery to be done or maintained under ICU, the same packages blocked for many patients on particular dates, and so on. There are also Human Intervention Triggers Against Hospital/TPA/Insurance.
  • Interactive Website: As of November 30th, 2019, 34,43,436 individuals had visited the website. There is an interactive “May I Help You” option for typical viewer queries. The webportal also allows the general public to check their eligibility and enrollment details using a simple web browser application.

Major Hospitals Affiliated with the West Bengal Health Scheme

  • Amalgamation of West Bengal Health Scheme hospitals, clinics, labs and diagnostic units
  • Medical facilities operated by municipal corporations/municipalities, as well as other local bodies.
  • Ramkrishna Mission Seva Pratisthan (Ramkrishna Mission Seva Pratisthan), Sarat Bose Road, Kolkata
  • Islamia Hospital in Kolkata; and Marwari Relief Society Hospital in Kolkata.
  • The Institute of Child Health is located at 11 Dr. Biresh Guha Street, Kolkata-17.
  • Balananda Brahmachari Hospital in Kolkata’s Behala district.
  • Kolkata’s Chittaranjan Cancer Hospital.
  • Ramkrishna Sarada Mission Matri Bhavan, Sree Mohan Lane, 7A, Kolkata-28
  • Kolkata’s Dr. M. N. Chatterjee Memorial Eye Hospital
  • Ramkrishna Matri Mangal Pratisthan and B.C. Roy Sishu Sadan, Ariadaha, North 24 Parganas
  • Kolkata’s J.N. Roy Sishu Seva Bhavan
  • Chartoris Hospital, Darjeeling’s Kalimpong.
  • The Kalimpong Leprosy Hospital in Darjeeling.
  • Sri Balaram Seva Mandir, North 24 Parganas, Khardah.

For Complete List of Hospitals Click Here

List of Swasthya Sathi’s Services

  • Hospital Empanelment
  • In addition, the hospital’s rating (That shall be based on infrastructure & services).
  • Cashless Transaction.
  • Electronic Health Records ( That Maintains health data after discharge of patient).
  • Interest is charged for late payments.
  • Online Complaints.
  • There is also call assistance accessible 24 hours a day, seven days a week.
  • Data in real time.
  • SMS Notifications of Card Issues
  • A shorter turnaround time of 30 days.
  • Swasthya Sathi Android App for mobile help.

View the Swasthya Sathi Notices.

  • First and foremost, visit the Swasthya Sathi scheme’s official website.
  • The home page will appear in front of you.
  • From the homepage, select the notice option.
swasthya-sathi-notices
  • A new page will appear in front of you.
  • A list of notices will be shown in front of you.
  • You must now click on the notification of your choice on this new page.
  • The necessary information will be shown on your computer screen.

Download the Orders of the Government.

  • Visit the official Swasthya Sathi website.
  • The home page will appear in front of you.
  • You are now on the government order page.
  • All government orders will be displayed in front of you.
  • •You must select an order by clicking on it.
  • A PDF file will appear in front of you.
  • A download button must be clicked in order to get it downloaded.

Tenders can be downloaded.

  • Go to the Swasthya Sathi scheme’s official website.
  • The home page will appear in front of you.
  • On the homepage, select the tenders option.
  • A list of tenders will be shown in front of you.
  • Select the tender of your choosing by clicking on it.
  • A PDF file will appear in front of you.
  • You must select the download option.
  • The tender will be saved on your device.

Administration and Team Formation

  • For further information, please visit the official website of the Swasthya Sathi Scheme
  • The home page will appear in front of you.
  • On the site, click on the About Swasthya Sathi Option link.
  • After that, you must select Administration and team setup.
Administration And Team Setup-SSS-min
Administration And Team Setup
  • A new page will appear in front of you.
  • •On this new page, you can examine Administration and team setup.

Structure of the Organization

  • Go to the official Swasthya Sathi website.
  • The home page will appear in front of you.
  • Now, select the Swasthya Sathi Option.
  • After that, you must select institutional structure.

Organizational Structure-SSS-min
Organizational Structure
  • A new page will appear in front of you.
  • On this new page, you may see the organisational structure.

Swasthya Sathi Helpline Number

The phone number for the helpline is 18003455384.

FAQ’s

I won’t be able to deposit my Swasthya Sathi card when I arrive?

If the Swasthya Sathi Card is not deposited within 24 hours after hospitalization, the Beneficiary will be responsible for the costs. You may also reach us 24 hours a day, seven days a week at 1800 345 5384. (Toll Free).

How do I determine the amount deducted and the amount remaining in my account?

  • An inpatient discharge slip and SMS received on the registered mobile phone are two examples of information that can be gathered from these sources.
  • Use the Mobile App, which you may get from the Google Play Store, and search for your URN number.
  • You may also reach us 24 hours a day, seven days a week at 1800 345 5384. (Toll Free).

Which hospitals are available for SWASTHYA SATHI recipients to receive treatment?

  • A list of hospitals (both public and private) is supplied at the time of enrollment; consult the hospital brochure for further information.
  • Dial the hotline number included with the smart card.
  • Using the Mobile App, you may search the network hospital under the ‘active hospital’ tab.
  • You may also look it up on our website, https://swasthyasathi.gov.in.

What kind of hospitals will be included on this list?

  • Based on the qualifying requirements, both public and private hospitals are empanelled.
  • As an example, Grade A, B, C, and R hospitals are rated based on their facilities and infrastructure.
  • The recipient has the option of selecting which hospitals they wish to visit.
  • You may look for available healthcare facilities using our Mobile App or our Website.

Which hospitals may the recipient visit for treatment?

  • A list of hospitals affiliated with the plan is supplied to beneficiaries at the time the card is issued.
  • Whenever a beneficiary needs medical attention, he or she must travel to one of these hospitals or any additional hospitals afterwards added to the list of empanelled hospitals.
  • Please double-check the information on our Mobile App/Website or call our Toll Free Call Center.

How will the recipient know which hospitals are eligible for Swasthya Sathi treatment?

  • A list of hospitals is supplied at the time of card issuing.
  • Calling the toll-free helpline number listed on the back of the Smart Card can give you with information about these and other hospitals (1800-345-5384).
  •  

Is there a cost for treatment at the hospital?

Swasthya Sathi is a cashless scheme, with treatment fees of up to Rs 5,00,000 (five lakhs per year per family) paid to the hospital through smart card. THE BENEFICIARY DOES NOT HAVE TO PAY FOR TREATMENT UNDER THE SWASTHYA SATHI SCHEME.

What precisely does “cashless service” imply?

The term “cashless service” alludes to the fact that the patient will not be charged for treatment or hospitalization.

Is there a fee to the patient for the medication?

As a result, pharmaceutical costs are already included in the price of Swasthya Sathi’s treatment packages.

Is SWASTHYA SATHI capable of doing both OPD and IPD?

OPD consultations are not covered; however, if the OPD is converted to IPD, the Scheme will cover the whole cost of treatment.

What if drugs or diagnostic services are unavailable at the hospital and must be acquired elsewhere?

It is the obligation of hospitals to provide all medications and diagnostics required for therapy. If the patient followed the Hospital’s advice/instructions when purchasing it, he or she can deposit the cash memo/receipt and claim the reimbursement.

What if you spend more than Rs. 200/- on transportation?

The payment for transportation under SWASTHYA SATHI is restricted to Rs. 200/- each hospitalisation and Rs. 2000/- every policy year.

However, if the treatment is received at any Government Hospital using a Swasthya Sathi card, an extra travel allowance of Rs 400/- to Rs 700/- is granted, and the recipient would receive Rs 400/- to Rs 700/- as transport allowance.

Will the recipient receive transportation allowance if they use their own vehicle?

Regardless of mode of transportation: Payment for transport under SWASTHYA SATHI is restricted to Rs. 200/- each hospitalisation and Rs. 2000/- in a policy year for private hospitals.

Is there a way to check the smart card’s balance?

  • Dial the hotline number included with the smart card.
  • Use the Mobile App, which may be downloaded from the Google Play Store.

What is the purpose of fingerprint verification?

By verifying a user’s finger prints, fraud and abuse of the smart card may be prevented.

When the beneficiary goes to the hospital, whose fingerprint is required?

Any registered member of the family’s fingerprint can be given.

How will the recipient be compensated for these expenses?

The hospital will supply the patient with the required medications, tests, and so on, and will repay upon proof of a bill of purchase.

What exactly are package charges? What exactly does it cover?

A package fee indicates that all treatment-related expenses, such as medicine, tests, bed costs, other materials, meals, and so on, are included in the package and will not be charged to the patient.

What if the illness is not included in the package rate? How long will the recipient have to wait?

If the illness is not covered by the package rate, the hospital will get authorization from the insurance company / SNA by submitting a Pre-Auth form before blocking the payments. This will happen within 24 hours, depending on the sort of illness.

What will happen if the hospital’s smart card reader fails?

As a result, the hospital and the insurance company / SNA will be responsible for making alternate arrangements in the event that the smart card reader fails. If the beneficiary’s identify is validated, no treatment will be withheld.

Where should the recipient go once they arrive at a SWASTHYA SATHI-accredited hospital?

SWASTHYA SATHI will be stationed at a hospital counter to help the patient.

Is there anything more the recipient has to bring to the hospital in addition to the smart card?

When coming to the hospital, the recipient just has to carry their smart card and any other government-issued identification case. Please also add your correct cell phone number so that we can serve you more effectively.

What if the recipient forgets to bring the smart card to the hospital for treatment? Will he be able to obtain the services?

A smart card is required to access the service. In extreme instances, the hospital may authorize it after proper verification, which SHOULD BE WITHIN 24 HOURS. Please notify the hospital that the Smart Card will be ready in 24 hours.

Is consultation and medication included?

If the consultation and medication result in hospitalization, they are reimbursed. Consultations with the OPD are provided at no cost to you.

Who will pay for testing and medications if there is no hospitalization?

If there is no hospitalization, the recipient must bear the cost.

What should a beneficiary do if a hospital requests payment from the beneficiary in the event of hospitalization?

A patient should promptly notify the DKM / SNA by calling the toll-free number listed in the pamphlet he received at the time of enrollment. The grievance can also be submitted using the Mobile App.

By Article Author

We have given you with all of the necessary information on the Swasthya Sathi project in this post. If you continue to have issues, you can call the hotline to get them resolved.

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